Chartis Top Reads – Week of September 13-19, 2020

Our research team breaks down this week’s top healthcare news.

Top Reads Overview

In an age of unprecedented change, staying current has never been more important. Our team at Chartis is curating news most relevant to the healthcare industry and tracking the topics that are trending on seven key issues: clinical quality and risk, digital and advanced technology, financial sustainability, health disparities, the health ecosystem of the future, partnerships, and the provider enterprise. Each week, we break down what’s happening and why it matters.

Digital and Advanced Technology

The Buzz This Week

More than six months into the pandemic, it is clear the proportion of physicians using telehealth has increased significantly. According to recent survey data from Decisions Resources Group, “80 percent of U.S. physicians had conducted a virtual patient consultation in the previous three months —up from 39 percent in April and 9 percent in early March, when use of virtual consults was unchanged over 2019 levels.” More than one-half of physicians surveyed intend to use telehealth post-COVID, with the biggest concern being the ability to deliver the same quality of care remotely.

Why it Matters

Telehealth’s rapid adoption was driven by the need for contactless care during the pandemic, but virtual care could have long-term success if organizations can demonstrate its benefit. Currently, telehealth “success” is measured through volume and usage statistics, such as application downloads and number of visits, rather than clinical process, quality, and outcomes measures (e.g., reduction of disease burden, access to providers, cost of care, and patient experience). Initial findings from one academic medical center indicate telehealth may provide better outcomes than in-person appointments for certain services, possibly due to fewer no-shows and same-day cancelations, lower cost of care, and improved patient experience. Telehealth’s longevity ultimately will depend on its ability to meet key organizational goals, including quality improvement, better clinical outcomes, enhanced patient experience, and positive economic returns.

Health Disparities

The Buzz This Week

COVID vaccine clinical trials are moving at a rapid pace. But ensuring that testing adequately includes, and distribution of a vaccine fittingly prioritizes, the “right” populations will be challenging. First, we likely will experience constraints in vaccine production volume, requiring an approach designed to prioritize the most vulnerable. The National Academy of Science has suggested an initial framework that prioritizes health workers, those with comorbidities, and older Americans living in overcrowded settings. However, critiques have pointed to the framework’s focus on individual risk rather than populations in aggregate. They have also highlighted that there is little mention of prioritizing Black and other racial and ethnic minority populations shown to have far worse outcomes with COVID-19, which should place them in the vulnerable group.

Second, there may be hesitancy among Black and minority populations to receive an approved vaccine even if they are prioritized. Despite the fact that Black participation is a stated key goal in clinical trials, actual Black enrollment in trials has been relatively low, and therefore Black Americans may not trust the trials. As Dr. Vladimir Berthaud, an infectious disease specialist and professor at Meharry Medical College, one of the nation’s oldest and largest historically Black academic health science centers, stated, “If you don’t have enough people like you in those vaccine trials, you will not know if it works for you.” But ensuring adequate Black trial enrollment is a challenge in itself. Historical atrocities, such as the Tuskegee syphilis experiments, have embedded a deep-seated mistrust of the testing process for some Black Americans. “Ongoing mistreatment by medical providers today” has been reported by many Black Americans. And the popular method of online recruitment limits the ability of populations with more limited internet access to enroll, including Black Americans. Finally, there is the potential barrier of inadequate payment to providers, de-incentivizing them to administer the vaccine.

Why it Matters

Americans who are Black, Indigenous, Latinx, Pacific Islanders, or over age 65 have all had higher death rates from the disease, so it is imperative that a vaccine is focused on protecting these vulnerable populations. A successful vaccination campaign requires trust in the government and medical community and a process that is fair and equitable. Historically Black medical institutions and current patients of Black physicians may be more willing to consider clinical trial participation and should be targeted. Doing so will help in increasing trust of an approved vaccine among Black populations and will increase the proportion that seek and receive the vaccine. And while the framework for vaccination priority that the National Academy of Science has proposed makes sense theoretically, the aforementioned critiques should be considered. Final recommendations on vaccine prioritization must take high-risk populations and those with multiple risk factors into account. In terms of access to the vaccine, we must consider that a high proportion of vulnerable populations are Medicare and Medicaid enrollees. Increases in government payment for vaccine administration for Medicare and Medicaid enrollees can help to ensure that those who are most vulnerable are able to find a provider to administer the vaccine.

Provider Enterprise

The Buzz This Week

While we are not yet in a post-COVID-19 environment, lessons already can be gleaned from the six months of experience tackling the pandemic across the globe. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, recently underscored at a Harvard Medical Grand Rounds the imperative components of successful pandemic response:

  • Careful and adequate preparedness (years of preparation and investment)
  • Respect for the potential impact without underestimation
  • Adherence to our established scientific research and testing methods
  • Ability to adapt quickly to new developments

Health system leaders have voiced more specific lessons and recommendations, including:

  • Having widespread testing capacity
  • Promoting or requiring evidence-based safety and infection prevention practices, such as mask-wearing
  • Caring for health professionals during and after the virus impacts them and/or their patients
  • Preparing for the combination of COVID-19 and seasonal flu

Both Fauci and other healthcare leaders have underscored the health disparities in COVID-19 outcomes — for Black populations and other people of color, and for the elderly and those with certain underlying diseases or conditions. These health leaders are urging the nation to address both the disparities evident with COVID-19 and the underlying health disparities that have been present for decades. The 2020 Scorecard on State Health System Performance, recently released by The Commonwealth Fund, can help identify and prioritize health disparities and their drivers within each state.

Why it Matters

While Fauci’s and other healthcare leaders’ recommendations may seem obvious, the U.S. did not follow many of them when COVID-19 arrived and suffered mightily as a result. In addition, much misinformation spread as we learned about the virus while trying to treat and contain it in real time. A more effective forum is needed to share information and best practices, rapidly arrive at recommendations or directives without abandoning established scientific and ethical methods, and disseminate information without twisting data or inserting politics.

Access to care and health disparities were (re-)exposed through COVID-19, and support has grown substantially for effort to improve public health and health equity. Newly available state health data includes public health spending by state (previously not reported), geographic differences in health factors and outcomes, and data on disparities between white people and people of color for indicators such as healthcare access, outcomes, and quality of care. This data should be utilized to identify opportunities to positively impact health status. However, we are in need of new approaches and significantly greater resources. We should increase budgets for health disparity reduction efforts; identify provider, community, and government partners that can work together; leverage innovations in treatments and care delivery models to reach the underserved; and establish ways to measure and sustain progress.


Contributors

Roger A. Ray. MD
Physician Consulting Director
[email protected]

Alexandra Schumm
Principal, Vice President of Research
[email protected]

Abigail Arnold
Research Manager
[email protected]


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SEPTEMBER 2020
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Week 1

AUGUST 2020
Week 4

Chartis Top Reads - Week of September 13-19, 2020 - The Chartis Group